Provider Demographics
NPI:1770162091
Name:HYSENI, ENERJETA
Entity type:Individual
Prefix:
First Name:ENERJETA
Middle Name:
Last Name:HYSENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8133 JEANES ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2346
Mailing Address - Country:US
Mailing Address - Phone:267-432-5228
Mailing Address - Fax:
Practice Address - Street 1:8133 JEANES ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19111-2346
Practice Address - Country:US
Practice Address - Phone:267-432-5228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA38423601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health